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<title>MINOR&#8217;S ASSUMPTION OF RISK AND RELEASE</title>
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<div class=3DSection1>

<p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;tab-stops:ce=
nter 3.85in;
mso-layout-grid-align:none;text-autospace:none'><b><span style=3D'font-size=
:18.0pt'>MINOR&#8217;S
ASSUMPTION OF RISK AND RELEASE<o:p></o:p></span></b></p>

<p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;tab-stops:ce=
nter 3.85in;
mso-layout-grid-align:none;text-autospace:none'><b><span style=3D'font-size=
:18.0pt'>AND
WAIVER OF UABIUTY<o:p></o:p></span></b></p>

<p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;tab-stops:95=
.5pt 409.6pt;
mso-layout-grid-align:none;text-autospace:none'><span class=3DGramE><span
style=3D'font-size:8.0pt'>DESCRIPTION AND </span><span style=3D'font-size:8=
.0pt;
font-family:Arial'>LOCATION OF </span><span style=3D'font-size:8.0pt'>VENT(=
S).</span></span><span
style=3D'font-size:8.0pt'><span style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbs=
p;
</span>DATE RELEASE </span><span style=3D'font-size:8.0pt;font-family:Arial=
'>SIGNED<o:p></o:p></span></p>

<p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;tab-stops:95=
.5pt 409.6pt;
mso-layout-grid-align:none;text-autospace:none'><span style=3D'font-size:8.=
0pt;
font-family:Arial'><o:p>&nbsp;</o:p></span></p>

<p class=3DMsoNormal style=3D'tab-stops:95.5pt 409.6pt;mso-layout-grid-alig=
n:none;
text-autospace:none'><span style=3D'font-size:8.0pt;font-family:Arial'><o:p=
>&nbsp;</o:p></span></p>

<p class=3DMsoNormal style=3D'text-align:justify;line-height:11.6pt;mso-lin=
e-height-rule:
exactly;tab-stops:10.2pt;mso-layout-grid-align:none;text-autospace:none'><s=
pan
style=3D'font-size:11.0pt;font-family:Arial;mso-bidi-font-weight:bold'>I ha=
ve
obtained my parent&#8217;s consent to participate in the </span><span
style=3D'font-family:Arial;mso-bidi-font-weight:bold'>above </span><span
style=3D'font-size:11.0pt;mso-bidi-font-weight:bold'>event(s). </span><span
style=3D'font-size:11.0pt;font-family:Arial;mso-bidi-font-weight:bold'>I
understand that I am assuming all </span><span style=3D'font-family:Arial;
mso-bidi-font-weight:bold'>of </span><span style=3D'font-size:11.0pt;font-f=
amily:
Arial'>the risks <span style=3D'mso-bidi-font-weight:bold'>if </span></span=
><span
style=3D'font-family:Arial;mso-bidi-font-weight:bold'>I </span><span
style=3D'font-size:11.0pt;font-family:Arial;mso-bidi-font-weight:bold'>get =
</span><span
style=3D'font-family:Arial'>hurt </span><span style=3D'font-size:11.0pt;fon=
t-family:
Arial;mso-bidi-font-weight:bold'>during the event(s), and I state the
following:<o:p></o:p></span></p>

<p class=3DMsoNormal style=3D'text-align:justify;line-height:11.6pt;mso-lin=
e-height-rule:
exactly;tab-stops:10.2pt;mso-layout-grid-align:none;text-autospace:none'><s=
pan
style=3D'font-size:11.0pt;font-family:Arial;mso-bidi-font-weight:bold'><o:p=
>&nbsp;</o:p></span></p>

<p class=3DMsoNormal style=3D'margin-left:15.0pt;text-align:justify;text-in=
dent:
-15.0pt;line-height:11.6pt;mso-line-heightt-rule:exactly;tab-stops:15.0pt;
mso-layout-grid-align:none;text-autospace:none'><b><span style=3D'font-size=
:11.0pt;
font-family:Arial'>1.<span style=3D'mso-tab-count:1'>&nbsp; </span></span><=
/b><span
style=3D'font-size:11.0pt;font-family:Arial;mso-bidi-font-weight:bold'>Both=
 my
parents </span><span style=3D'font-size:11.0pt;font-family:Arial'>and <span
style=3D'mso-bidi-font-weight:bold'>I believe I am </span></span>qualified =
<span
style=3D'font-size:11.0pt;font-family:Arial;mso-bidi-font-weight:bold'>to
participate in the event(s). I will </span><span style=3D'font-size:11.0pt;
font-family:Arial'>inspect <span style=3D'mso-bidi-font-weight:bold'>the pr=
emises
and </span></span><span style=3D'font-family:Arial'>equipment </span><span
style=3D'font-size:11.0pt;font-family:Arial;mso-bidi-font-weight:bold'>and =
if, at
any time, I </span><span style=3D'font-family:Arial'>feel anything to be </=
span><span
style=3D'font-size:11.0pt;font-family:Arial;mso-bidi-font-weight:bold'>unsa=
fe, I
will immediately leave and refuse to </span><span style=3D'font-size:11.0pt;
font-family:Arial'>participate further in the event(s)<o:p></o:p></span></p>

<p class=3DMsoNormal style=3D'text-align:justify;line-height:11.6pt;mso-lin=
e-height-rule:
exactly;tab-stops:15.0pt;mso-layout-grid-align:none;text-autospace:none'><s=
pan
style=3D'font-size:11.0pt;font-family:Arial'><o:p>&nbsp;</o:p></span></p>

<p class=3DMsoNormal style=3D'margin-left:15.0pt;text-align:justify;text-in=
dent:
-15.0pt;line-height:11.6pt;mso-line-heightt-rule:exactly;tab-stops:15.0pt;
mso-layout-grid-align:none;text-autospace:none'><span style=3D'font-size:11=
.0pt;
font-family:Arial'>2.<span style=3D'mso-tab-count:1'>&nbsp; </span>I unders=
tand
that the ACTIVITIES OF THE </span><span style=3D'font-family:Arial'>EVENT <=
/span><span
style=3D'font-size:11.0pt;font-family:Arial;mso-bidi-font-weight:bold'>ARE =
VERY
DANGEROUS and INVOLVE RISKS AND DANGERS OF MY BEING SERIOUSLY INJURED OR HU=
RT,
MY BEING PARALYZED OR KILLED.<o:p></o:p></span></p>

<p class=3DMsoNormal style=3D'text-align:justify;line-height:11.6pt;mso-lin=
e-height-rule:
exactly;tab-stops:15.0pt;mso-layout-grid-align:none;text-autospace:none'><b=
><span
style=3D'font-size:11.0pt;font-family:Arial'><o:p>&nbsp;</o:p></span></b></=
p>

<p class=3DMsoNormal style=3D'margin-left:15.0pt;text-align:justify;text-in=
dent:
-15.0pt;line-height:11.6pt;mso-line-heightt-rule:exactly;tab-stops:15.0pt;
mso-layout-grid-align:none;text-autospace:none'><b><span style=3D'font-size=
:11.0pt;
font-family:Arial'>3.<span style=3D'mso-tab-count:1'>&nbsp; </span></span><=
/b><span
style=3D'font-size:11.0pt;font-family:Arial;mso-bidi-font-weight:bold'>I kn=
ow </span><span
style=3D'font-size:11.0pt;font-family:Arial'>that these <span style=3D'mso-=
bidi-font-weight:
bold'>risks </span>and <span style=3D'mso-bidi-font-weight:bold'>dangers ma=
y be
caused by my own </span>actions <span style=3D'mso-bidi-font-weight:bold'>o=
r </span></span><span
style=3D'font-family:Arial'>inactions, </span><span style=3D'font-size:11.0=
pt;
font-family:Arial;mso-bidi-font-weight:bold'>the actions or inactions of </=
span><span
style=3D'font-size:11.0pt;font-family:Arial'>others <span style=3D'mso-bidi=
-font-weight:
bold'>participating in the event(s), the rules of the event(s), the </span>=
condition
<span style=3D'mso-bidi-font-weight:bold'>and layout of </span>the <span
style=3D'mso-bidi-font-weight:bold'>premises and equipment, and/or the <b>N=
EGLIGENCE</b>
of others, </span>including <span style=3D'mso-bidi-font-weight:bold'>those
persons </span></span><span style=3D'font-family:Arial'>responsible </span>=
<span
style=3D'font-size:11.0pt;font-family:Arial;mso-bidi-font-weight:bold'>for
conducting </span><span style=3D'font-size:11.0pt;font-family:Arial'>the,
event(s)~<o:p></o:p></span></p>

<p class=3DMsoNormal style=3D'text-align:justify;line-height:11.6pt;mso-lin=
e-height-rule:
exactly;tab-stops:15.0pt;mso-layout-grid-align:none;text-autospace:none'><s=
pan
style=3D'font-size:11.0pt;font-family:Arial'><o:p>&nbsp;</o:p></span></p>

<p class=3DMsoNormal style=3D'margin-left:15.0pt;text-align:justify;text-in=
dent:
-15.0pt;line-height:11.6pt;mso-line-heightt-rule:exactly;tab-stops:15.0pt;
mso-layout-grid-align:none;text-autospace:none'><b><span style=3D'font-size=
:11.0pt;
font-family:Arial'>4.<span style=3D'mso-tab-count:1'>&nbsp; </span></span><=
/b><span
style=3D'font-size:11.0pt;font-family:Arial;mso-bidi-font-weight:bold'>1 HE=
REBY </span><span
style=3D'font-family:Arial'>ASSUME </span><span style=3D'font-size:11.0pt;
font-family:Arial;mso-bidi-font-weight:bold'>ALL SUCH RISKS, EVEN IF </span=
><span
style=3D'font-family:Arial'>THE </span><span style=3D'font-size:11.0pt;font=
-family:
Arial;mso-bidi-font-weight:bold'>RISKS </span><span style=3D'font-size:11.0=
pt;
font-family:Arial'>ARE </span><span style=3D'font-family:Arial'>CREATED </s=
pan><span
style=3D'font-size:11.0pt;font-family:Arial;mso-bidi-font-weight:bold'>BY <=
/span><span
style=3D'font-family:Arial'>THE </span><b><span style=3D'font-size:11.0pt;
font-family:Arial'>NEGLIGENCE</span></b><span style=3D'font-size:11.0pt;
font-family:Arial;mso-bidi-font-weight:bold'> of the </span><span
style=3D'font-size:11.0pt;font-family:Arial'>promoters, </span><span
style=3D'font-family:Arial'>participants, <span style=3D'mso-bidi-font-weig=
ht:bold'>racing
</span>associations, sanctioning organizations, or any <span style=3D'mso-b=
idi-font-weight:
bold'>of its </span>subdivisions, </span><span style=3D'font-size:11.0pt;
font-family:Arial;mso-bidi-font-weight:bold'>track operators, </span><span
style=3D'font-size:11.0pt;font-family:Arial'>track owners, officials, car o=
wners,
drivers, pit crews, rescue personnel, <span style=3D'mso-bidi-font-weight:b=
old'>any
</span></span><span style=3D'font-family:Arial'>persons in any </span><span
style=3D'font-size:11.0pt;font-family:Arial'>restricted <span style=3D'mso-=
bidi-font-weight:
bold'>areas, promoters, sponsors, advertisers, owners, arid </span>lessees =
<span
style=3D'mso-bidi-font-weight:bold'>of </span></span><span style=3D'font-fa=
mily:
Arial'>premises </span><span style=3D'font-size:11.0pt;font-family:Arial;
mso-bidi-font-weight:bold'>used to conduct the events, premises or event </=
span><span
style=3D'font-size:11.0pt;font-family:Arial'>inspectors, surveyors, <span
style=3D'mso-bidi-font-weight:bold'>underwriters, </span>consultants, </spa=
n><span
style=3D'font-family:Arial'>and </span><span style=3D'font-size:11.0pt;font=
-family:
Arial;mso-bidi-font-weight:bold'>any </span><span style=3D'font-family:Aria=
l'>other
</span><span style=3D'font-size:11.0pt;font-family:Arial;mso-bidi-font-weig=
ht:
bold'>person or </span><span style=3D'font-size:11.0pt;font-family:Arial'>e=
ntity <span
style=3D'mso-bidi-font-weight:bold'>who </span>gives </span><span
style=3D'font-family:Arial'>recommendations, </span><span style=3D'font-siz=
e:11.0pt;
font-family:Arial;mso-bidi-font-weight:bold'>directions, or instructions, or
engages in risk evaluation, </span><span style=3D'font-family:Arial'>loss c=
ontrol
</span><span style=3D'font-size:11.0pt;font-family:Arial'>activities or </s=
pan><span
style=3D'font-family:Arial'>sales regarding </span><span style=3D'font-size=
:11.0pt;
font-family:Arial;mso-bidi-font-weight:bold'>the premises or. </span><span
class=3DGramE><span style=3D'font-size:11.0pt;font-family:Arial'>events</sp=
an></span><span
style=3D'font-size:11.0pt;font-family:Arial'>, <span style=3D'mso-bidi-font=
-weight:
bold'>and each of </span></span><span style=3D'font-family:Arial;mso-bidi-f=
ont-weight:
bold'>them, their </span><span style=3D'font-family:Arial'>officer&#8217;s =
arid
employees, </span><span style=3D'font-size:11.0pt;font-family:Arial'>all <s=
pan
style=3D'mso-bidi-font-weight:bold'>of </span></span><span style=3D'font-fa=
mily:
Arial;mso-bidi-font-weight:bold;mso-bidi-font-style:italic'>which are </spa=
n><span
style=3D'font-size:11.0pt;font-family:Arial;mso-bidi-font-weight:bold'>refe=
rred
to as </span><span style=3D'font-family:Arial'>&#8220;Releasees.&#8221;.&#8=
221;<o:p></o:p></span></p>

<p class=3DMsoNormal style=3D'text-align:justify;line-height:11.6pt;mso-lin=
e-height-rule:
exactly;tab-stops:15.0pt;mso-layout-grid-align:none;text-autospace:none'><s=
pan
style=3D'font-family:Arial'><o:p>&nbsp;</o:p></span></p>

<p class=3DMsoNormal style=3D'margin-left:15.0pt;text-align:justify;text-in=
dent:
-15.0pt;line-height:11.6pt;mso-line-heightt-rule:exactly;tab-stops:15.0pt;
mso-layout-grid-align:none;text-autospace:none'><b><span style=3D'font-size=
:11.0pt;
font-family:Arial'>5.<span style=3D'mso-tab-count:1'>&nbsp; </span></span><=
/b><span
style=3D'font-size:11.0pt;font-family:Arial;mso-bidi-font-weight:bold'>I HE=
REBY </span><span
style=3D'font-size:11.0pt;font-family:Arial'>RELEASE, <span style=3D'mso-bi=
di-font-weight:
bold'>WAIVE, COVENANT NOT TO SUE, AND DISCHARGE,</span> ALL <span
style=3D'mso-bidi-font-weight:bold'>OF THE </span>RELEASEES <span
style=3D'mso-bidi-font-weight:bold'>FROM </span></span><span style=3D'font-=
family:
Arial'>ALL </span><span style=3D'font-size:11.0pt;font-family:Arial;mso-bid=
i-font-weight:
bold'>LIABILITY TO ME, my </span><span style=3D'font-family:Arial'>personal
representatives, assigns, </span><span style=3D'font-size:11.0pt;font-famil=
y:
Arial;mso-bidi-font-weight:bold'>heirs, and next of </span><span
style=3D'font-family:Arial'>kin, </span><span style=3D'font-size:11.0pt;fon=
t-family:
Arial'>for <span style=3D'mso-bidi-font-weight:bold'>any and all loss or </=
span></span><span
style=3D'font-family:Arial'>damage <span style=3D'mso-bidi-font-weight:bold=
'>and </span></span><span
style=3D'font-size:11.0pt;font-family:Arial'>any <span style=3D'mso-bidi-fo=
nt-weight:
bold'>claim or </span>any <span style=3D'mso-bidi-font-weight:bold'>demand =
on
account of any </span>injury <span style=3D'mso-bidi-font-weight:bold'>to me
including, but </span>not limited </span><span style=3D'font-family:Arial;
mso-bidi-font-weight:bold'>to, my </span><span style=3D'font-size:11.0pt;
font-family:Arial'>death, <span style=3D'mso-bidi-font-weight:bold'>whether=
 </span>caused
</span><span style=3D'font-family:Arial;mso-bidi-font-weight:bold'>by the <=
/span><span
style=3D'font-size:11.0pt;font-family:Arial;mso-bidi-font-weight:bold'>NEGL=
IGENCE
</span><span style=3D'font-family:Arial;mso-bidi-font-weight:bold'>of the <=
/span><span
style=3D'font-family:Arial'>Releasees or </span><span style=3D'font-size:11=
.0pt;
font-family:Arial;mso-bidi-font-weight:bold'>otherwise.</span><span
style=3D'font-family:Arial'><o:p></o:p></span></p>

<p class=3DMsoNormal style=3D'text-align:justify;line-height:11.6pt;mso-lin=
e-height-rule:
exactly;tab-stops:15.0pt;mso-layout-grid-align:none;text-autospace:none'><b=
><span
style=3D'font-size:11.0pt;font-family:Arial'><o:p>&nbsp;</o:p></span></b></=
p>

<p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;tab-stops:15=
.0pt;
mso-layout-grid-align:none;text-autospace:none'><b><span style=3D'font-size=
:11.0pt;
font-family:Arial'>I HAVE </span></b><b style=3D'mso-bidi-font-weight:norma=
l'><span
style=3D'font-family:Arial'>READ </span></b><b style=3D'mso-bidi-font-weigh=
t:normal'><span
style=3D'font-size:11.0pt;font-family:Arial'>THE <span style=3D'mso-bidi-fo=
nt-weight:
bold'>ABOVE </span>ASSUMPTION <span style=3D'mso-bidi-font-weight:bold'>OF =
RISK
AND </span>RELEASE <span style=3D'mso-bidi-font-weight:bold'>AND </span></s=
pan></b><b
style=3D'mso-bidi-font-weight:normal'><span style=3D'font-family:Arial'>WAI=
VER </span></b><b><span
style=3D'font-size:11.0pt;font-family:Arial'>OF </span></b><b style=3D'mso-=
bidi-font-weight:
normal'><span style=3D'font-size:11.0pt;font-family:Arial'>LIABILITY, <span
style=3D'mso-bidi-font-weight:bold'>UNDERSTAND </span>WHAT I HAVE READ, <sp=
an
style=3D'mso-bidi-font-weight:bold'>AND </span></span></b><b style=3D'mso-b=
idi-font-weight:
normal'><span style=3D'font-family:Arial'>SIGN IT </span></b><b><span
style=3D'font-size:11.0pt;font-family:Arial'>VOLUNTARILY.</span></b><b
style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:11.0pt;font-=
family:
Arial'><o:p></o:p></span></b></p>

<p class=3DMsoNormal style=3D'text-align:justify;tab-stops:15.0pt;mso-layou=
t-grid-align:
none;text-autospace:none'><b><span style=3D'font-size:11.0pt;font-family:Ar=
ial'><o:p>&nbsp;</o:p></span></b></p>

<p class=3DMsoNormal style=3D'text-align:justify;tab-stops:15.0pt;mso-layou=
t-grid-align:
none;text-autospace:none'><b><span style=3D'font-size:4.0pt;font-family:Ari=
al'><o:p>&nbsp;</o:p></span></b></p>

<p class=3DMsoNormal style=3D'text-align:justify;tab-stops:15.0pt;mso-layou=
t-grid-align:
none;text-autospace:none'><b><span style=3D'font-size:4.0pt;font-family:Ari=
al'><o:p>&nbsp;</o:p></span></b></p>

<p class=3DMsoNormal style=3D'text-align:justify;tab-stops:15.0pt;mso-layou=
t-grid-align:
none;text-autospace:none'><span style=3D'font-size:8.0pt;font-family:Arial;
mso-bidi-font-weight:bold'>________________________________________________=
____________<span
style=3D'mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span=
>_______________________<br>
<span
style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;
</span>SIGNATURE OF MINOR PARTICIPANT<span style=3D'mso-tab-count:4'>&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>DATE<o:p></o:=
p></span></p>

<p class=3DMsoNormal style=3D'text-align:justify;tab-stops:15.0pt;mso-layou=
t-grid-align:
none;text-autospace:none'><span style=3D'font-size:8.0pt;font-family:Arial;
mso-bidi-font-weight:bold'><o:p>&nbsp;</o:p></span></p>

<p class=3DMsoNormal style=3D'text-align:justify;tab-stops:15.0pt;mso-layou=
t-grid-align:
none;text-autospace:none'><span style=3D'font-size:8.0pt;font-family:Arial;
mso-bidi-font-weight:bold'><o:p>&nbsp;</o:p></span></p>

<p class=3DMsoNormal style=3D'text-align:justify;tab-stops:15.0pt;mso-layou=
t-grid-align:
none;text-autospace:none'><span style=3D'font-size:8.0pt;font-family:Arial;
mso-bidi-font-weight:bold'>________________________________________________=
____________<span
style=3D'mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span=
>_______________________<br>
<span
style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;
</span>PRINTED NAME OF MINOR PARTICIPANT<span style=3D'mso-tab-count:4'>&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>AGE<o:p></o:p></span></p>

<p class=3DMsoNormal style=3D'text-align:justify;tab-stops:15.0pt;mso-layou=
t-grid-align:
none;text-autospace:none'><span style=3D'font-size:8.0pt;font-family:Arial;
mso-bidi-font-weight:bold'><o:p>&nbsp;</o:p></span></p>

<p class=3DMsoNormal style=3D'text-align:justify;tab-stops:15.0pt;mso-layou=
t-grid-align:
none;text-autospace:none'><span style=3D'font-size:8.0pt;font-family:Arial;
mso-bidi-font-weight:bold'><o:p>&nbsp;</o:p></span></p>

<p class=3DMsoNormal style=3D'text-align:justify;tab-stops:15.0pt;mso-layou=
t-grid-align:
none;text-autospace:none'><span style=3D'font-size:8.0pt;font-family:Arial;
mso-bidi-font-weight:bold'>___________________________________________<span
style=3D'mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp; </span>_________________________________________<br>
<span
style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span>WITNESS<span style=3D'mso-tab-count:4'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp=
;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&n=
bsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp=
;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&n=
bsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><span
style=3D'mso-spacerun:yes'>&nbsp; </span>PRINTED NAME OF WITNESS<span
style=3D'mso-tab-count:4'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><o:p></o:p></span></p>

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